Some Things Never Change
by Zana Zira
Summary: It's strange how much Sam seems to have changed since he left for Stanford, how he doesn't seem to want his big brother's help with anything anymore. But when Sam's attempts at healthy living manage to make him sick instead, he'll see that having Dean around again may not be so bad after all. Sick!Sam, caring!Dean. Set in Season 1, between "Wendigo" and "Dead in the Water."


**Disclaimer: Supernatural and its characters are the property of Eric Kripke. Sadly, I do not own any of these guys.**

**Warnings: Puke. A lot. If you get grossed out very easily, you probably shouldn't read this while eating.**

**A/N: I don't know why, but this plotbunny was demanding sick Sam and wouldn't leave me alone until I wrote it. And we've been learning about pathogenic bacteria, especially those that cause food poisoning, in my microbiology lab course, so of course I had to apply that knowledge somewhere. Thus, we have this story, which started out at three pages and slowly became nine.**

* * *

"Dude, seriously?" Dean asked in exasperation as Sam contemplated the "Salads" section of the enormous diner menu, which was fixed in place under the glass tabletop. "We come to a diner with some of the best burgers and chicken around and you're ordering a freakin' _salad_?"

Sam just shrugged, mostly ignoring his brother while he continued to read over the many choices that appealed to him. For once, not everything at this place was dripping with gravy or grease, and he was going to make the most of it. He hadn't found a truly good salad since they had left Palo Alto, and he had gotten out of practice when it came to eating nothing but gas-station burritos and takeout every day. Dean could eat double-fried meat all he wanted, but today Sam wanted to cleanse at least a little of the trash probably already beginning to seep into his arteries.

"Are you boys about ready to order?"

Sam's head snapped up at the sound of their waitress's voice, realizing he had been studying the menu more intensely than he thought.

"Uh, yeah," he answered slowly. "I think I'll have the strawberry spinach salad."

"And I'll have the Route Sixty-Six burger with a side of fries. Actually, better make that two," Dean said after glancing at Sam and deciding that a salad was definitely not going to be enough to keep his Sasquatch of a brother full until the late evening. If he didn't want to eat it now, fine; it would definitely keep until he was hungry again.

"Comin' right up," the woman said cheerfully, jotting down their orders and heading back toward the kitchen at a quick clip.

"Two? Really?" Sam asked, his classic bitch-face making a brief appearance as he looked at his older brother. "You're gonna make yourself sick eating all that at once."

"Well thanks for your concern, Francis, but they aren't both for me," Dean snapped back, taking a sip of his Coke and setting the glass back down a little more forcefully than necessary. "You're a freakin' giant, and I know if a little spinach ain't enough to keep _me_ full from here to Springfield it _really_ won't be enough for you. Just planning ahead."

Sam's face fell a little, a slight blush creeping up into his cheeks when he realized what a jerk he must have sounded like. He'd gotten so used to taking care of himself over the last four years that he'd almost forgotten how much Dean always tried to look out for him, even after he had long outgrown the need for it. He should have known what Dean was trying to do; nothing about the older Winchester had changed, after all – only _Sam_ was different.

"Right. Well, uh, thanks," he said awkwardly, happy to note that Dean let it go immediately and went back to staring at a cute girl he'd spotted across the room.

Before long their meals arrived, and Dean hungrily devoured his burger while Sam flipped through a few notes he'd taken for the upcoming case and poured a little bit of sweet dressing on his dark green salad.

"So, the way these bodies look practically screams 'black dog,'" he said through a mouthful of spinach. It was even better than he'd expected, a perfect mix of savory and sweet thanks to the chicken and strawberries in the leaves. "It shouldn't be too much trouble, but we should still get there as soon as we can before it attacks anyone else."

"Yeah," Dean said after swallowing an enormous bite of burger. "What is it with people and sneaking into cemeteries in the middle of the night? Especially since they all claim not to believe in the supernatural. Are they just having a midnight picnic, or what?"

"I dunno. If they had any idea what was out there they'd never try anything that stupid…"

Dean looked up at Sam, the distant gaze and sad tone in his voice indicating that his little brother was back to thinking about Jess. And when wasn't he lately? Dean wished he could make it stop, make the nightmares and the flashbacks and the guilt all just stop, but he knew the only one who could do that was Sam. At least the kid had finally started eating and sleeping like a normal person again – most of the time, anyway.

It had worried the older Winchester to no end when his little brother seemed to simply quit functioning after Jessica's death, especially since the time at Stanford had apparently made Sam want to reject every attempt Dean made at helping him or making him feel better. He knew part of it was that Sam had always been independent, hating to be babied, but even then he'd always made an exception when it came to his big brother. Now, though… Dean wasn't sure when things had become so different between them, but they definitely were. Sam didn't want his help anymore, and Dean was just going to have to get used to it.

Once he'd polished off his fries and noticed that Sam's bowl of salad was just short of being licked clean, Dean called the waitress over and paid the check, packing up the second burger in a to-go box for his brother to eat later. It was going to be almost eight hours from this little north-Texas town to the hunt in Springfield, Missouri, and he didn't want to have to make any more pit-stops than they absolutely needed to. Sam didn't say much as they piled into the car and backed out, likely still thinking about Jessica. Dean left him alone, knowing that interrupting his daydreams wasn't going to help, and turned up the music instead. To his relief, it only took about a half-hour for Sam to fall asleep in the passenger seat. Maybe just this once he'd be able to stay asleep for the entire trip.

* * *

They had been driving for a little over three hours when Dean noticed Sam beginning to stir slightly in the seat beside him. It was subtle, just a few twitches of his feet and a scrunching of his eyes, but Dean knew that was getting dangerously close to nightmare territory. It didn't take much these days to turn Sam from slight twitching to whimpering and screaming, and Dean turned down the music a little so he'd be better able to hear if his little brother started to sound distressed enough to need waking.

To his surprise, though, Sam settled down again almost immediately, his features as relaxed as if he had never moved at all. Relieved, Dean turned his attention back to the road, humming the notes to "Enter Sandman" under his breath as it played on the car radio. He was really looking forward to an easy hunt. That last one with the Wendigo hadn't worked out as well as he hoped, and he really needed to get used to having Sam as a hunting partner again before they took on another perfect killer like that. This would give them both a chance to get back in the swing of things, especially since Sam had a lot of polishing up to do after all his time away from the job.

And speaking of Sam…

Dean glanced over when he noticed his brother moving again in the corner of his eye. His eyebrows came closer together as he looked harder at him, noticing something didn't seem quite right. Sam's lips had pulled down into a frown, and his skin was shining with a thin layer of sweat and very pale, almost gray. As Dean watched, his arms slowly rose up to wrap around his midsection, and he groaned softly in his sleep. Another dream about how Jess had died? If it was, it had gone on long enough. Dean was about to reach over and wake Sam up when his eyes opened on their own. He blinked blearily a couple of times, and then his face seemed to grow even paler as he stared at the open road in front of them.

"Dean… Pull the car over," Sam said an instant later, his hands fisted tight at his sides.

"What? Why? We're not even halfway there."

Before Sam could answer, the Impala's right front tire dipped into a pothole, making the car bounce roughly. Sam brought a hand up to cover his mouth and made a choked-off sound in the back of his throat, a hybrid of a gasp and a hiccup that Dean had been familiar with since his brother was still in diapers. It always meant two things: one, that he was sick to his stomach and it had gotten too bad to hide it anymore; and two, that there was going to be puke everywhere in about three seconds if Dean didn't act very, very quickly.

"Alright Sammy, okay, hold on," he said in a rush as he quickly pulled the car over to the shoulder and threw it into park. Sam's free hand had been fumbling with his seatbelt before they even stopped, and as soon as they did he flung the passenger door open wide, falling out onto the asphalt on his knees with his head hanging low between his arms. He was gulping furiously in between harsh breaths as he gave one last futile effort to stop the inevitable, and Dean sighed when he came around the front of the car and saw his brother's struggle.

"Come on, dude, quit fighting it," he said firmly as he knelt beside his brother, rolling his eyes when Sam shook his head and panted harder.

"Don't want… to…" he gulped out between spasmodic swallows.

"No one wants to," Dean said, knowing how much Sam hated throwing up ever since he was a kid. "But you need to."

"Yeah…" He swallowed a couple more times and leaned a little further forward. "But I still really hate –"

Whatever he was going to say was cut off when he gagged harshly, doubling over as everything he'd eaten recently made a violent reappearance. Dean winced at the sight but didn't move from Sam's side, keeping a steady hand on his back to let him know he was there if he needed him. Sam kept his eyes closed, trying not to see his lunch in repeat as wave after wave of it poured from his mouth onto the asphalt. He held himself up with one arm, the other held tight to his belly while it clenched again and again and left him desperately gasping for breath in between.

"Take it easy, Sammy," Dean coached, patting his brother's back after he tried to puke and breathe at the same time and just ended up choking on his own spit. "You'll feel better in a minute."

Sam nodded, giving in to the dry heaves for a couple more minutes and then finally settling down. He panted tiredly, spitting a long string of bile onto the ground and then wiping his mouth disgustedly with the back of his hand.

"Alright, you good?" Dean asked, getting up and retrieving a bottle of water for Sam.

"I think so…" Sam answered slowly, swishing a mouthful of water around and spitting it out with a grimace before drinking a few large sips. "Sorry, I don't know what happened. That just came out of nowhere."

"Well you didn't puke in my baby, so no harm done," Dean said with a teasing smile. He waited until Sam was back in the car and then looked him over, not liking how nauseated he still seemed even after supposedly getting rid of whatever hadn't agreed with him. "What do you say we hit the motel early tonight?" he asked, trying to sound as nonchalant as he could.

Sam didn't fall for it.

"No. We need to get to Springfield by nightfall or that black dog might kill even more people. Let's just keep going."

"But Sam –"

"Really Dean, I'm fine. Okay?" He attempted a reassuring smile, although to Dean it looked more like a pained grimace, and the older Winchester rolled his eyes and sighed.

"Yeah. Okay."

They lasted about another twenty minutes before pulling over for Sam to throw up all the water he'd just drunk. Neither of them got out of the car this time; Dean just hung on to Sam so he wouldn't fall onto his face when he leaned his head out the door and hurled onto the side of the road. By the time he finished retching he was exhausted, paler than before, and clearly in at least a little bit of pain. He shook his head and swallowed hard when Dean offered him water again, and the older Winchester decided enough was enough.

"Alright, Sam. You're sick – too sick to hunt," he added when it looked like Sam might protest. "We're gonna find a motel and then you can sleep it off. End of discussion."

Sam sighed wearily, but he looked almost grateful, and Dean felt a lot better as he turned the car around and started driving back the way they'd come. He was pretty sure he'd seen a motel a few miles back, and it hadn't looked half bad. Whatever Sam was coming down with, he deserved a little better than a roach motel for the time being. Or at least he did if Dean had anything to say about it.

* * *

Sam stayed in the car while Dean hurried inside and got them a room, his head leaning against the cool glass of the window and his breathing slow and measured. He desperately willed his stomach to behave at least long enough to get inside; even if he knew Dean _probably_ wouldn't murder him for hurling in the Impala, he didn't want to test that theory if he didn't have to. But his head was pounding, he was hot and shaky, and that to-go burger in the backseat was really starting to stink up the car like grease… He gulped, the nausea ratcheting up dramatically. _Oh no, hurry up Dean…_

As if in response to his plea, his brother rounded the corner an instant later, hurriedly unlocking the door to their room and propping it open. While Dean went to get their bags, Sam dashed inside and skidded into the bathroom, barely making it to his knees before he was retching so hard he expected to see his liver join the mix any second. There wasn't even anything substantial to throw up now, just watery spit and strings of neon bile that forced him to close his eyes so he wouldn't see them and get sick all over again. He could barely breathe between the spasms that seemed to radiate through his entire body instead of just his stomach, and he felt about as weak as a newborn kitten.

This was more than just his lunch not agreeing with him. No way he'd feel this worn out so quickly otherwise. And it might have been just his imagination, but he was feeling a little bit hot, too… Just when he thought he couldn't hold himself up anymore, Sam heard his big brother dropping their bags on the floor and making his way to the tiny bathroom. He had never been happier to hear those boots clomping against the tile in his life.

"Hey, hey, easy," Dean said gently when he saw Sam's arms suddenly give out beneath him. He hurriedly reached out and caught Sam around the waist, the other hand cupping his forehead to keep him from whacking his chin on the rim of the toilet. The sudden motion and the extra pressure on his abdomen sent Sam into another fit of dry heaves, and he immediately shifted so he was holding his brother by the shoulders and chest instead. "Just take it easy, Sammy," he said as he moved his other hand from Sam's forehead to his back. "You don't even have anything left to puke up."

"Guh… Ow…" Sam moaned between fruitless heaves, hands clenched over the trembling muscles of his belly. He could feel Dean's hand slowly rubbing circles on his back, trying to work out some of the knots of tension between his shoulder blades, and he sighed, coughing and spitting into the water. "This really… sucks…"

"I know, man." Dean hummed at the amount of heat radiating from Sam's skin but didn't comment on it. "You think you're good for now?"

"Yeah, I – gah!" He doubled over again, forehead resting on the filthy floor and back arching while he clamped white-knuckled hands over his stomach.

"Sam?!" Dean bent further down to try to see his brother's face. "What's wrong?"

"Nothing… just… cramp…" Sam gritted out, kneading his fingers into the muscles over and over as he slowly began convincing them to relax. "Surprised me… is all. Ah, God, hurts…"

"Breathe through it, Sammy," Dean said softly, still rubbing between his shoulders in small, slow circles. He didn't care how much this broke his usual "No chick-flick moments" rule; Sam was in pain, and that was more important. "It'll pass, just breathe."

Dean sat with him for a few minutes, patiently waiting until Sam relaxed, laying his head on his crossed arms with a weary sigh. He didn't waste any time in dragging him to his feet, slowly guiding him to the bed farthest from the door and pulling his boots off before helping him get settled under the covers. Sam looked exhausted, and Dean didn't like how shaky and weak he seemed. Probably getting dehydrated too, if he had to guess. Sam only took a few hesitant sips of the Gatorade from the vending machine, and only after the Pepto Bismol Dean offered him, but it all stayed down with no sign of reappearing and Dean was counting that as a victory.

What worried him, though, was how much pain his brother still seemed to be in. Stomach bugs sucked, sure, but they usually didn't have his extremely pain-tolerant Sasquatch of a brother curled up into a shivering ball so soon after they hit. Then there was the fact that he seemed to be running a fever, and the pallor and sweating… An icy feeling of dread settled in his chest as he realized what might be wrong, and he pulled back the bedcovers so he could palpate Sam's abdomen for anything unusual.

"What are you doing?" Sam asked irritably, squirming when Dean's fingertips pressed into his belly through his shirt again, just to the right of center.

"Checking to make sure your spleen's still there," he snarked, still focused on his task.

"Dean, the spleen's on the left. You of all people would know –" Suddenly the lightbulb seemed to come on in his head, and he laid back and closed his eyes, his next words tired and soft. "It's not my appendix, Dean."

"Yeah? And how do you know that?"

Sam's response was almost inaudible, but it hit Dean like a punch to the face.

"Because I don't have one anymore."

That got his attention, and Dean immediately ceased his ministrations, looking up at Sam in disbelief.

"Since when?"

Because he damn well would have remembered Sam needing his freaking appendix out. Unless… Maybe he wasn't there when it happened…?

"My first year at Stanford. I, uh, came down with a pretty bad case of appendicitis. Almost didn't get it out before it ruptured, but my roommate had had it before and recognized it, so he took me to the E.R. It wasn't any big deal," he added when he saw the strangely stricken look on his older brother's face.

"Not a big deal?" Dean repeated, glaring at Sam hard enough that there should have been holes burned through him already. "Not a _big deal_? My brother gets sick enough to need to have _surgery _and no one thinks to _tell me_? It's been over three years since then, Sammy!"

"I know," Sam said quietly, eyes cast downward in shame as he tried to shrink as far into the comforter as he could. "I wanted to call you, I just… didn't think it mattered anymore."

Dean stared wide-eyed at him, mouth gaping like a fish's, before he sighed and let his shoulders sag.

"You're right. I guess to you it must not have mattered anymore," he said slowly, standing and making his way toward the door to their room with his keys in hand. "And maybe you didn't even think Dad would care. But it sure as hell would've mattered to me, Sam. It matters to me _now._"

"Dean –" Sam started, trying to sit up and groaning when all it did was pull muscles that were currently too tired to hold him up properly. "Wait, that isn't what –"

"We'll talk about this later, Sam," Dean cut him off before he could finish. "I need to pick up some supplies while we're in town. Stay here and get some rest."

The door closed before Sam could say anything further, and left with no other option, he decided to take his brother's advice and get a little rest. Judging by how sick he was starting to feel again, it wouldn't last long anyway.

* * *

Dean had heard Sam calling out to him as he closed the door to the motel, but he just couldn't bring himself to keep talking about this right then. It hurt to think Sam hadn't even needed his support while he was at Stanford – hurt like freakin' hell – but this wasn't the time to start a fight with his hard-headed little brother. Sam was sick, and he was tired and weak and hurting, and picking a fight with him now would be completely unfair, not to mention totally counter-productive to helping him get better.

So Dean had put his anger and hurt on the back burner for the time being, instead driving to the nearest grocery store to pick up some essential supplies for dealing with stomach bugs: chicken broth, saltines, ginger ale, and even some Pedialyte in case the dehydration got bad enough for Gatorade to be insufficient. Of course, Dean would probably haul Sam's ass to the hospital long before he got that bad, but still… He even picked up a bag of uncooked white rice, which he would be able to heat up in the microwave and make a hot-pack that, he knew from personal experience, was very effective at soothing muscles that were worn out and aching from too much vomiting.

He had just finished paying for everything and was making his way back out of the store when he noticed a small flyer hanging on a bulletin board labeled "Recalls." When he took a closer look, he immediately recognized the object on display, and his eyes widened in disbelief. It was a recall for salad dressing, and the bottle in the picture was identical to the one Sam had used at the diner earlier that afternoon. Apparently this "Strawberry Vinaigrette" had been improperly processed prior to shipment, and everyone in Oklahoma and the surrounding area was being urged to return all opened and unopened bottles to avoid coming down with _Bacillus cereus_ food poisoning.

"Son of a bitch," Dean muttered. "Food poisoning from _salad dressing_? Seriously?" He sighed as he started up the Impala, glad to know what they were dealing with but cursing their family's unfortunate luck. When he reached the motel and got out of the car, he shook his head and chuckled bitterly to himself. "Only you could manage to get yourself poisoned by healthy stuff, Sammy."

He opened the door with one hand, bags held tight in the other, and was preparing himself to deal with the emotional conversation that surely awaited him when the sound of retching stopped him cold. He immediately flung the door wide, grimacing when he saw that Sam hadn't been able to make it out of bed before getting sick this time. There was Pepto-Bismol-Gatorade puke all over his shirt, as well as on the sheets and down the side of the bed. Dean guessed he'd probably been asleep and had no warning before his body decided it was still tired of keeping anything down, and he kicked himself for not leaving a trashcan close at hand just for that reason.

When Dean walked in, Sam was laying with his head hanging over the edge of the mattress, coughing and gasping miserably as another bout of dry-heaves assaulted his already abused body. When they finally eased off and he realized Dean was there, he pushed himself up, trying futilely to both hide the mess and apologize to Dean for their earlier conversation.

"Dean, I… I'm sorry about what… I'll clean this up, I didn't mean to –"

"Whoa, whoa, slow down," Dean said firmly, dropping the grocery bags on the table and helping Sam free himself from the disgusting sheets. "It's not your fault, okay? You just managed to get yourself sick with a little bad salad dressing."

"Huh?"

"Yeah, I just saw the recall at the store," Dean said, tossing Sam a clean shirt and throwing the cloth rice bag into the microwave to heat up while he changed. "I told you all that healthy crap was bad for you. Turns out that vinaigrette you put on your salad was contaminated with some kinda bacteria when they processed it. You'll be puking for another day or so, but the good news is it usually doesn't go the other direction."

"Lucky me," Sam muttered, sinking into one of the hard chairs at the table and laying his head down exhaustedly. Dean didn't respond, just striding over to Sam's bed and pulling all of the soiled sheets off at once before wadding them up and tossing them into the dirty bathtub. He could do laundry later, but right now that wasn't his biggest concern.

"Here," he said, setting a new bottle of Gatorade in front of Sam, along with some Dramamine he had picked up at a pharmacy on the way back. "Drink a little of this with those pills and then we'll get you to bed. They should work a lot better than the Pepto."

Sam hesitated but swallowed the pills and a few mouthfuls of the drink, pushing it away when he'd drunk as much as he thought he could stand. Then he looked over at his own bed, sighing tiredly.

"Think I'll just take the floor," he muttered. "You can't pay me enough to get back in that bed."

"I didn't say _that_ bed," Dean answered calmly, pulling the bag of rice from the microwave after feeling it to decide if it was hot enough. When Sam blinked up at him in confusion, he just shrugged. "You're sick, your bed's filthy, and we'll both fit fine in a queen-size. Don't make it weird."

"No, I just… Thanks."

"Yeah, yeah. Just get in bed before this gets cold." He handed Sam the bag of rice, and he immediately hugged it to his aching belly, curling around it with a sigh of relief at the soothing heat. A moment later Dean placed something beside him on the floor, and then crossed to the other side of the bed and sat against the headboard. "There's a trashcan right there if you need it. I don't really care about those sheets on your bed, but if you puke on _me_ we're gonna have problems. Got it?"

Sam smiled, moving further under the covers and shifting so he was lying on his back with the rice bag sitting on his stomach. He was already starting to fall asleep, completely exhausted and finally getting a little bit of relief. "Mmm-hmm," he mumbled. "I got it…"

Seconds later he was dead to the world, and Dean found the remote and turned the TV on, muting the volume and reading the captions so he wouldn't wake Sam up.

About an hour after he started watching TV, Dean felt Sam shifting under the blankets next to him, and then his little brother was pressed against his side, curled around his leg and hip like he used to when he was little and having a bad dream. And just like then, all Dean had to do was rub his back a little, shush him and tell him to go back to sleep, and he settled immediately, snoring as he unknowingly cuddled tighter against his big brother.

Dean smiled. Sam might pretend not to need anyone to look after him anymore, but some things about him were never going to change. And in the morning, he was going to tease Sam mercilessly for this.

Just not now.

* * *

**Please leave a review and let me know what you thought of this story. I'd love to hear!**


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